A Case of Round Ligament Lipoma-induced Sacless Sliding Fatty Inguinal Hernia

Abstract

A 74-year-old woman presented with a chief complaint of a lump in the right groin. Computed tomography revealed a right inguinal hernia with protruding fat, and elective surgery was scheduled. Although laparoscopic examination did not reveal peritoneal depression, incision of the peritoneum and dissection of the preperitoneal layer revealed a mass that protruded through the internal ring into inguinal canal. When the tissue surrounding the mass was removed, a tumor was observed arising from the round ligament. After laparoscopic tumor resection, repair of the internal inguinal ring, dilated to approximately 2 cm, was performed using a mesh. The mass was pathologically diagnosed as lipoma. No recurrence was observed approximately one year after surgery. Though it has been proposed in Europe and America, the concept of sacless sliding fatty inguinal hernia (SSFIH), which is characterized by symptoms similar to an inguinal hernia and is caused by the protrusion of spermatic cord/round ligament lipoma or preperitoneal fatty tissue without peritoneal depression, is not widely known in Japan. In this report, we present and discuss a rare case of SSFIH caused by round ligament lipoma and review the literature.